- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $1,047.13
| Professional | | $363.08 | $537.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,412.54
| Professional | | $323.59 | $562.34 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,023.29
| Professional | | $549.54 | $776.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $616.60 / $1,148.15
| Professional | | $331.13 | $616.60 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $977.24
| Professional | | $309.03 | $524.81 | $977.24 |